Making Radiology Work Flow


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Making Radiology Work Flow

  1. 1. Making Radiology Work Flow Linda DiMeo The Next Frontier: An Integrated Medical Information Technology Platform Laura Newman Reprints from Medical Solutions, RSNA 2006
  2. 2. COVER STORY WORKFLOW RADIOLOGIST JAMES BUSCH, MD, Director of Informatics for Diagnostic Radiology Consultants, now also heads the private practice group’s IT arm called Specialty Networks. Making Radiology Work Flow Having the right information available at the right time and place, linking resources together and using them more effi- ciently, accomplishing more tasks in a shorter period of time – in short, optimizing workflow to improve quality and reduce costs – is at the center of implementing infor- mation technology in health- care. A group of radiologists in Chattanooga, TN, USA, not only recognized this trend, but decided to go for it. By Linda DiMeo
  3. 3. COVER STORY WORKFLOW During the past ten years, medicine has been experiencing a trend toward decentralization, with outpatient care becoming more the norm. While this has resulted in the desired cost efficiency, it has unfortunately also resulted in a loss of communication between healthcare providers, slower turnaround times and greater opportunities for medical errors caused by lost, outdated, or mistranscribed data. With the aid of Siemens Medical Solutions technology, Diagnostic Radiology Consultants (DRC) has managed to integrate a complex, multistate and multisite radiology practice into an unified environment, which has resulted in increased speed, simplicity, flexibility, profitability, and, most importantly, improved patient care and safety. Founded more than 50 years ago, DRC is a private practice group of eleven radiologists who read and interpret approximately 200,000 cases per year, generated from multiple sites across the greater Chattanooga and northern Georgia region. As they would travel from site to site to interpret images, DRC radiologists found themselves changing IT platforms with virtually every facility they visited. The variety of radiology information systems (RIS), picture archiving and commu- nication systems (PACS), and postprocessing systems they were using was causing con- fusion, inefficiency, and delays. To complete a case, a radiologist could deal with as many as four different platforms, one for RIS, one for PACS, one for voice interpretation, and yet another for postprocessing functions. In many cases, this involved moving back and forth among several workstations, each with a separate log on and password. Adding to the inefficiency was the fact that the radiologists were often unable to view images that were taken at a facility with a different PACS. And since the transcription systems were not integrated with the RIS, the radiologists had to redictate patient information before even beginning the body of their reports. The DRC radiologists began discussing the benefits of an enterprise-wide integrated solution at all the facilities they service. They decided to try to find a vendor that offered a solution in which RIS, PACS, postprocessing, and transcription came together in a compre- hensive package. If such a product existed, they talked about incorporating it into all of the facilities at which they interpreted. From that idea, Specialty Networks was born – a corporation that would become the infor- mation technology (IT) arm of Diagnostic Radiology Consultants.
  4. 4. 4 MEDICAL SOLUTIONS RSNA 2006 COVER STORY WORKFLOW “We immediately began to assess the tech- nology that was available to serve our goals,” says James Busch, MD, Director of Specialty Networks, and Radiologist and Director of Informatics for DRC. “Not only did we want to find a vendor that would be a good partner and offer an enterprise-wide solution, but also one that was looking down the path of integration for the future.” From fall 2004 to summer 2005, Specialty Networks conducted vendor evaluations, and in the end, chose Siemens Medical Solutions. “Siemens was the only vendor that offered exactly what we were looking for and was also interested in continuing to refine the integration of the various software platforms that radiologists use to do their jobs,” says Busch. Specialty Networks chose syngo® Suite, a comprehensive IT solution from Siemens that provides integration at the RIS, PACS, postprocessing, and transcription levels. On the RIS end, syngo Workflow manages the processes for the exchange and distribution of patient data and images from end to end. The PACS applications for diagnostic prepara- tion, quality assurance, and diagnostic inter- pretation are bundled into syngo Imaging. syngo Voice* is the component of syngo Work- flow offering voice recognition and transcrip- tion solutions within syngo Suite. Specialty Networks chose Siemens strategic partner NextGen Healthcare Information Systems, Inc., a leading provider of electronic medical record and practice management solutions, to provide its electronic practice management (EPM) solution. Siemens had been working closely with NextGen to streamline the patient experience from patient access through diagnosis to treatment. The NextGen® EPM solution has been completely integrated with syngo Suite, extending the comprehensive IT solution to include scheduling as well. Thus, with one keyboard, one mouse, and a single password-protected log on, syngo Suite would cover the entire imaging process for Specialty Networks, from patient registration and diagnosis to image distribution. With syngo Suite, the radiologists of DRC would finally be able to communicate with each other, and with technologists, clerks, and referring physicians, in a uniform, consistent manner, at all times. Implementing syngo Suite Once Specialty Networks chose Siemens as a partner, it began arranging to incorporate syngo Suite in the facilities where it inter- preted studies. Specialty Networks selected Galen Imaging, which is the outpatient imag- ing center for Galen Medical Group, as the first site to implement syngo Suite. With a total of eight locations spread throughout the greater Chattanooga and northern Georgia area, Galen was a perfect candidate in which to conduct volume testing, averaging 22,000 exams per year. In October 2005, Galen became the first successful go-live of Siemens »Siemens was the only vendor that offered exactly what we were looking for.« James Busch, MD, radiologist, Director, Specialty Networks, Director of Informatics, DRC, Chattanooga, TN, USA * Currently available with the U.S. version of syngo Workflow only.
  5. 5. MEDICAL SOLUTIONS RSNA 2006 5 COVER STORY WORKFLOW University Hospital Erlangen: The Art of Individualizing Standards Discussing workflow topics with Professor Stephan Achen- bach, MD, is no easy task. Instead of answering my ques- tion regarding his department’s workflow in cases of acute chest pain, the Assistant Medical Director for Cardiology and Angiology at the Hospital of the Friedrich-Alexander- University Erlangen-Nuremberg, Germany, asks in return: “What is workflow?” Considering his following explanation, “Every patient presenting to the emergency unit with acute chest pain is different – you can’t just squeeze them into standardized flowcharts,” he sure is right. Just think of how differently people experience chest pain in the first place. “It would be a true piece of art to develop a workflow that leaves enough space for the individuality of each patient,“ he says. Nevertheless, he and his colleagues send patients with clear acute chest pain, electrocardiograms (ECG) with- out elevated ST-levels, and inconclusive blood tests to a computed tomography (CT) scan to exclude acute myocardial infarction (MI) as the cause of the pain. Achenbach expects both medical benefits – due to faster treatment initiation for patients with acute MI – and economic advantages – due to shorter stays in the emer- gency room for other patients – from this procedure. “We have to work economically without practicing sub- par medicine,” he says, “and I think CT can be very useful in doing so,” even if standardizations are difficult. With an early CT diagnosis, the President of the Society for Cardiovascular CT sees the chance to intervene early on and put the patient on the right track for treatment. One major problem he perceives in establishing this new workflow as a rule once its medical and economic merits are scientifically proven, however, is staffing: “You need to have a physician and a technologist available at all times, who can run a cardiac CT. There are not many around yet.” Exploring Data Flow To Achenbach, like most other physicians, more important than a standardized, step-by-step patient workflow is data flow. Having ECG, laboratory, image, and any other patient data available is key when it comes to determining a final diagnosis and treatment decision – wherever that decision may be taken. The Imaging Science Institute (ISI), a cooperation of the Global Solutions Division of Siemens Medical Solutions and the University Hospital Erlangen, provides a platform to investigate possibilities to solve this issue of seamless data availability, among other projects. As an interdisciplinary research institution housed within the university hospital, ISI is dedicated to analyzing treat- ment processes. It is supported by excellent medical expertise, a powerful information technology (IT) infra- structure and the latest generation of diagnostic systems. The aim is to improve the overall workflow, from patient admission to discharge, and to define optimized treat- ment paths for specific diseases. Holistic treatment paths are developed, tested, and optimized using Siemens work- flow-oriented software systems syngo and Soarian®. Implemented within a modern hospital, these treatment paths enable extensive automation of administrative processes, so that scheduling, data exchange, and billing can be done at the push of a button. The result is a streamlined workflow that allows doctors and hospital staff to concentrate on what is important – the patients and their treatment. dpi THE IMAGING SCIENCE INSTITUTE is dedicated to looking beyond current workflow concepts.
  6. 6. 6 MEDICAL SOLUTIONS RSNA 2006 COVER STORY WORKFLOW RIS/PACS integrated with the NextGen EPM system. The implementation was conducted as a phased installation to minimize the risk of downtime, and the eleven radiologists of DRC rotated their time at Galen so they could each train on the new system. Since then, the technology is currently being implemented in the remaining seven other DRC customer sites, including the largest multi-specialty medical group in the Chattanooga region, a 300-bed community medical center, and one of the largest orthopedic groups in the area. They are in negotiations to add at least two more clients to their roster. According to Busch, customers have been very enthusiastic about implementing the new technology at their facilities. “Installation week is always a bit difficult, because staffs have to learn to use the new technology and make adjustments to their workflow pro- cesses,” says Busch. “But they are eager to roll with it because they know that in the long run their jobs will be much easier and they will be more self-sufficient. They like the idea of having this cutting-edge technology at their fingertips.” Janice Cooke, the RIS/PACS Manager for Specialty Networks, is amazed at how well the implementation has gone. “I expected that it would take at least a year to bring the first five sites online,” she states. “The fact that this was accomplished in five months is incredible.” Cooke attributes the success of the implemen- tation to the team Siemens provided to over- see the project. “Of course, there have been small hardware and software issues along the way, but the whole adventure has been overwhelmingly smooth. I’ve been in radiol- ogy since 1978, and this is by far one of the best systems I’ve ever used. It’s easy to use, easy to fix problems, and easy to train staff on. It’s just an excellent system.” Busch also credits the Siemens team for the success of the implementation. “Siemens was extremely accommodating and supportive.” Reaping the Benefits of syngo Suite According to Busch, DRC has already saved more than one full-time radiologist, and expects to save even more in the future. “I don’t think we’ve even remotely reached our peak efficiency with syngo Suite,” he says. DRC has also drastically reduced turnaround time, from an average of 24 hours to one hour, and in some cases, just minutes. “Now, when we call doctors to give them reports, they often already have them in their hands,” explains Busch. “syngo has really helped us to differentiate ourselves in the marketplace.” Busch adds that making their practice more efficient has also made it more profitable. “The most expensive part of a radiology prac- tice is the radiologist, so it is extremely cost- effective to do more exams with less staff,” he states. syngo Suite has also contributed to improving the overall quality of patient care. “With inte- grated RIS and PACS, patient demographics are already in the system and don’t have to »It’s easy to use, easy to fix problems, and easy to train staff. It’s just an excellent system.« Janice Cooke, RIS/PACS Manager, Specialty Networks, Chattanooga, TN, USA JANICE COOKE (RIGHT) and James Busch, MD, look back at the successful implementation of syngo Suite at DRC and its customers’ sites.
  7. 7. MEDICAL SOLUTIONS RSNA 2006 7 COVER STORY WORKFLOW Continuous Improvements: Thinking Beyond Imaging Systems Siemens Medical Solutions constantly develops new and improved workflow solutions. Among the most recent developments are: ■ syngo Chorus MR*, which, for the first time ever, opti- mizes magnetic resonance imaging (MRI) workflow beyond the scanner, enabling a perfect synergy between the modality and the radiology information system (RIS) and the picture archiving and communication system (PACS) environment. From the moment the patient is scheduled in the RIS, syngo Chorus MR goes to work: The application cross-checks patient data and validates order entry based upon diagnosis. With the Protocol Planning functionality of syngo Chorus MR, the radiologists can plan the MRI exams right out of the RIS – providing the MR technologist with the exact protocol that he or she wants to be run – without unnecessary phone calls or clarifications. Beyond that, if the patient is scheduled for a follow-up study, using the PhoenixZIP functionality of syngo Chorus MR, the protocols previously used can be sent to the MRI scanner, so that exactly the same parameters are reproduced, and comparative diag- nosis can easily be made. This saves time and enables diagnostic accuracy. Using the Protocol Distribution functionality of syngo Chorus MR, the RIS can also distribute MRI protocols from one MRI scanner over the network to all other Siemens scanners running on the latest MRI software. This helps ensure standardization of protocols through- out the different MR suites and optimizes quality. The new Inline Billing (MPPS) follows the patients’ process progress. At the end of the procedure, the system bills automatically. Inline Billing even supplies the associated codes necessary to report back to the RIS with no manual entry. ■ syngo WebSpace is a real pace setter. It offers instant, web-based access to imaging data plus state-of-the-art 2D, 3D and 4D postprocessing tools – enterprise-wide and beyond. Real-time streaming of reconstructed imaging data to the server allows up to 20 concurrent users instant access to data via the PACS or any personal com- puter (PC)** client throughout the institution, in their home office or while traveling, by simply connecting to the net- work. “For a large institution such as Johns Hopkins, this client- server solution means that we can offer all our staff access to computed tomography (CT) data, 24/7. Now our physicians can have access where*** and when they need it and not just at the workstations in our 3D lab or at the scanner. The client server solution expands our capabilities to deliver outstanding patient care and improve workflow,” explains Professor Elliot Fishman, MD, of Johns Hopkins Medical Center in Baltimore, MD, USA. “Plus it’s syngo-based, which means we don’t have to invest time and resources in retraining staff.” syngo WebSpace is also ideally suited for short-term storage of thin-slice CT data, giving users instant access while avoiding the need to send all thin-slice data sets directly to the PACS, freeing up the CT scanner database at the same time. It can be fully integrated into an existing PACS and IT environment. The simple client-server archi- tecture is highly cost effective not only because of its multi-user capability, but also because it makes use of existing computer resources. dpi syngo WEBSPACE enables 3D reading anytime, anywhere. * 510(k) pending. ** PC must meet minimum requirements. *** Internet connection required.
  8. 8. 8 MEDICAL SOLUTIONS RSNA 2006 COVER STORY WORKFLOW Battlefield Auxiliary Breast Center: Workflow, Technology, and Tender-loving Care Make a Difference For many women, the experience of getting even a routine mammography screening can be a bit unnerving. And for those who have suspicious breast lumps, it can be downright nerve-wracking. But for women in northwestern Georgia, the process is not quite as daunting, thanks to Battlefield Auxiliary Breast Center. The first digital imaging center in the northern Georgia region, Battlefield Imaging of Ringgold, GA, USA, was formed in 2004 as a joint venture between Hutcheson Medical Center and Diagnostic Radiology Consultants (DRC). A world-class imaging center offering a full range of services, Battlefield Imaging opened its Battlefield Auxiliary Breast Center just 18 months later. The Comforts of Home Battlefield Auxiliary Breast Center was designed with the com- fort of patients as top priority. “Our goal was to create a safe haven for women,” says John Nelson, MD, Medical Director of Battlefield Imaging and DRC radiologist. “I think that providing women with this kind of atmosphere makes a difference for them in terms of their comfort and privacy.” Battlefield Auxiliary Breast Center provides a full range of breast imaging services, such as screening and diagnostic digital mammography, ultrasound, magnetic resonance imaging, and positron emission tomography/computed tomography (PET·CT), to help diagnose breast cancer in its earliest and most treat- able stages. The geographic layout of the center lends itself to fluid movement throughout a patient’s visit. The diagnostic and screening rooms are contiguous to the mammography suite, which is directly across the hall from the ultrasound suite. “Once a woman comes into the dressing room, she liter- ally never has to walk more than five feet to get where she needs to go for her exams,” says Nelson. The Battlefield Breast Center’s scheduling procedures have also been instrumental in making breast imaging a less daunting experience for women. “It’s very frightening for a woman who has a symptom such as a lump in her breast,” says Nelson. “For that reason, we make every effort to accommodate these patients by getting them into the schedule right away, usually on the same day that they call to request an appointment. Once they come in, our staff performs the necessary non- invasive tests all in that same visit, until we are completely satisfied that we’ve done everything we can to obtain a thorough diagnosis. If we determine that an invasive proce- dure, such as a biopsy, is necessary, then we will schedule that as soon as possible.” State-of-the-Art Digital Technology Battlefield Auxiliary Breast Center was one of the first to unveil the latest all-digital mammography technology, the heart of which is Siemens MAMMOMAT® NovationDR . The MAMMOMAT NovationDR offers digital mammography, digital spot imaging, and digital, imaging-based stereotactic biopsy. Its large plate facilitates more precise imaging of large breasts, and a specially designed compression plate enables central isocentric breast positioning. It also helps make calcifications easier to see in women who have dense breasts. Another benefit of the MAMMOMAT NovationDR is its significantly accelerated work- flow. The Center averages about one complete case every eight minutes, and performs 45 to 50 mammogram screen- ings and eight to12 diagnostic mammograms per day. Once images are acquired with the MAMMOMAT NovationDR , they are sent to the syngo MammoReport breast care work- place, which offers two five-megapixel monitors specially suited for reading and reporting mammograms. The radiology infor- mation system (RIS) drives the mammograms one at a time, or up to ten studies can be loaded at a time. Once they are selected, they can be loaded into syngo MammoReport almost instanta- neously and then can be filed with the click of a button. Patients’ old film studies can also be digitized and viewed with the syngo MammoReport. Nelson says that because of the magnification power of the technology, Battlefield’s callback rate has dropped to about 20 percent of what is used to be. “We rarely have to call patients back in to retake views,” he BATTLEFIELD IMAGING offers full-field digital mammography (FFDM), as well as other exams.
  9. 9. MEDICAL SOLUTIONS RSNA 2006 9 COVER STORY WORKFLOW be dictated again, which drastically reduces the risk of associating an image with the wrong patient,” says Busch. “We simply click on the patient’s name and go. This allows us to focus on the image interpretation, rather than being distracted by redundant docu- mentation requirements. And the sooner we can make a diagnosis and deliver a report, the sooner the patient can begin getting treatment.” To provide the highest quality of care possible, DRC has radiology specialists who are experts at interpreting images of specific systems of the body. For example, their neuroradiologist interprets special images of the brain and neck. In the past, these images would have to be saved until the neuroradiologist rotated through that particular imaging facility. But now with syngo Suite, radiologist specialists can access patient images immediately, using their individual worklists, no matter which facility they happen to be working at on a particular day. This is an added benefit for both the patient and the referring physician. Since the implementation of syngo, Specialty Networks has also added syngo Portal Radi- ologist* to its syngo Workflow RIS technology. A ’cockpit’ of sorts, syngo Portal Radiologist lays out on a computer screen all the tasks that a radiologist needs for his specific work processes. Every element on the screen is expandable and collapsible, so the radiolo- gist can manipulate how much or how little he wants to see of each item. syngo Portal Radiologist offers several advantages over the previous technology that DRC was using. “Probably the biggest benefit is that everything is concisely organ- ized on one screen,” says Busch. “There’s no need to toggle back and forth between different views or between old and new reports. Everything you need is right there on your desktop.” states. “Concerning the examination itself, up to 70 percent of our patients have reported that MAMMOMAT NovationDR is more comfortable than other systems. Another big advantage is that we are able to immediately sit down with the patient at the syngo MammoReport and go over her study. This leaves patients with a sense that their mammograms have been thoroughly evaluated.” All Under One Roof The fact that Battlefield Auxiliary Breast Center is on the same campus as a comprehensive cancer center, ambulatory surgical center, and a physicians’ office complex, also makes quick, convenient care for the patients possible. “Once a woman is diagnosed with a malignancy, she will probably require a host of services involving appointments with various healthcare providers,” says Nelson. “It’s very unusual for a patient to be able to obtain all this care in one place, yet that’s what we offer here on this campus. She can see an oncologist right here in our physicians’ complex, she can have any surgeries she needs in our surgical center, she can have radiation therapy here at the Breast Center, in addition to any follow-up imaging that needs to be done. It’s hard enough to deal with breast cancer without having to run all over the place for different appointments at different locations. Having all this care avail- able virtually under one roof has been invaluable to our patients.” ldm JOHN NELSON, MD, considers patient comfort a top priority in mammography screening situations. * Currently available for U.S. market only – under development for other markets.
  10. 10. 10 MEDICAL SOLUTIONS RSNA 2006 COVER STORY WORKFLOW New York University Medical Center: When Time is of the Essence There is little doubt that stroke patients are best treated in dedicated stroke centers. However, at many medical institutions a stroke center cannot be established, either due to limited space, or limited financial or personnel resources. New York University (NYU) Medical Center is in the ideal situation of not only having a stroke unit, but also being able to identify the patients that need to be treated there directly in the emergency room (ER). “Patients with acute symptoms indicating a possible stroke go straight to the ER’s 16-slice Siemens computed tomography (CT) scanner,” states Robert I. Grossman, MD, Louis Marx Professor of Radiology, Chairman of the Department of Radiology, and Professor of Neurosurgery, Neurology and Physiology, and Neuroscience. The perfunctory CT exam reveals immediately whether the symptoms are caused by an ischemic or hemorrhagic stroke, or if the ER physicians need to look for other causes, such as low blood sugar. A radiologist is present in the ER 24/7 to provide fast turnaround when time is of the essence. He or she interprets the images right on-site. Reports are usually dictated into a voice recognition system, but since the radiologist and ER physician work in close proximity to one another, the radiologist can give a preliminary oral report before he or she starts dictat- ing, thereby expediting treatment. Once the diagnosis is clear, the patient is referred to the NYU’s stroke center, where further treatment decisions are made depending, among other factors, on the patient’s age and condition, and on the type, location, and expanse of the stroke. Treatment, including, if possible, intravenous or intracranial thrombolysis, commences. Treatment results are monitored either by CT or magnetic resonance imaging (MRI). Both imaging modalities, as well as ultrasound, also play an important role when it comes to finding the actual cause of the stroke once the acute situation is resolved. Examinations also include a cardiac work-up and a complete blood analysis. dpi “syngo Portal Radiologist also lets you create ad hoc workflows, which we weren’t able to do in the past. If I am sitting at my computer reading an exam, and a referring physician calls in for a consultation, I can go into an ad hoc workflow and call his exam up on the screen without interrupting the images I’m already working on or losing the dictation that I’ve already done. That’s a tremendous advantage in terms of productivity and time savings.” Another functionality accessible in syngo Portal Radiologist is also contributing to quicker turnaround and more efficient service. The Dynamic Loading function allows images to appear as soon as they are selected from the worklist, so radiologists can begin their interpretation before the entire series loads. This is especially beneficial with large exams. And sophisticated postprocessing tools, which previously would have required moving to another workstation, are now available in the same integrated system. Additional advantages of syngo Portal Radi- ologist that Busch points out include the ability to create shortcuts and templates on the fly, and to obtain real-time feedback on productivity, improved search functionality, and better communication between radiolo- gists and technicians. With its familiar look and feel for all modalities and workplaces, syngo Portal Radiologist is easy to learn, use, and share. “The learning curve is very short, especially for those who are already familiar with the syngo environ- ment,” says Busch. “I learned it in one day, but even for someone who had never used syngo before, I’d say the average learning time would be one to two days.” “I like to compare syngo Suite to a stetho- scope,” explains Busch. “It’s a tool that can come with me, as a radiologist, wherever I go, similar to family doctors and their stetho- scopes. It has also allowed us to provide a single imaging software solution where radiologists and other doctors can go to get everything ‘imaging’ that they need. This has brought back a sense of community among physicians that had been lost in recent years
  11. 11. MEDICAL SOLUTIONS RSNA 2006 11 COVER STORY WORKFLOW due to the decentralization of imaging asso- ciated with the increase in outpatient care.” Securing Patient Privacy Although syngo Suite transfers all images into a centralized PACS architecture, these images are segregated by location, with each facility driven by a different master index. This means that radiologists at DRC can view images from all the medical practices that they serve, but each medical practice only has access to the images of its own patients. To illustrate, this is akin to someone looking at the windows of a high-rise building and being able to see what is going on simulta- neously on each floor, while the people on the individual floors can only see what is happening on their own floors, even though they are all in the same building. “This segregation and regulation based on user privileges is extremely important for patient privacy, and is not available with any other imaging technology on the market,” says Busch. Integrating Imaging Technology – Now and in the Future Dr. Busch hopes to expand the role-based workflow allowed with syngo Portal Radiolo- gist by implementing the syngo Portal Refer- ring Physician as soon as it becomes available. A web-based portal, syngo Referring Physician allows medical practices to link into a hospi- tal or other imaging provider’s diagnostic and therapeutic workflow. “syngo Portal Referring Physician would be a huge marketing advantage to us because it would allow us to provide referring doctors with even greater convenience in terms of scheduling and obtaining reports,” Busch is convinced. “These two factors play a great role in deciding where doctors will refer their patients for imaging.” “There is much being said about the need for greater IT adoption in healthcare and the integration of imaging and IT, but Siemens is the vendor that is making it happen and meeting our business model needs today,” says Dr. Busch. “From a standalone imaging center perspective, having RIS/PACS inter- operating with an EPM system provides a complete solution for managing our imaging workflow – from scheduling and registration to interpretation – and that is what we’ve achieved through our partnership with Siemens.” Author: Linda DiMeo is a freelancer writer, editor, and proofreader based in Philadelphia, PA, USA. She has 18 years of experience in the communications field, and holds a BA in English from St. Joseph’s University in Philadelphia. »syngo Portal Referring Physician would be a huge market- ing advantage to us.« James Busch, MD, radiologist, Director, Specialty Networks, Director of Informatics, DRC, Chattanooga, TN, USA
  12. 12. BUSINESS IMAGE MANAGEMENT 12 MEDICAL SOLUTIONS RSNA 2006 The Next Frontier: An Integrated Medical Information Technology Platform Breaking new ground, a partnership between Siemens and New York University is driving the development of new imaging software proto- types that will achieve efficiencies well beyond current industry expectations by focusing on integration over interfacing. By Laura Newman At last, the barriers to optimized workflow throughout radiology, cardiology, and oncol- ogy are coming down. Siemens Image and Knowledge Management Division is contribut- ing to this exciting development by focusing on image and workflow management appli- cations and computer-aided diagnosis under the roof of its syngo® software platform. Ajit Singh, PhD, who is heading the division, met with Bernard A. Birnbaum, MD, Professor of Radiology and Vice Chairman of Clinical Affairs and Operations at New York University’s (NYU) Department of Radiology, to talk about NYU’s needs and the innovative products Siemens has in the pipeline to revolutionize how work is organized in imaging depart- ments and medical networks around the globe. MEDICAL SOLUTIONS: Until now, workflow in radiology has been somewhat fragmented. What strategies do you see as paving the way to the radiology department of the future? SINGH: If I think ahead, our end goal is to have all the relevant information and knowl- edge – which is context and role sensitive – in the right place at the right time. By that, I mean at the point of decision making and the point of care. That is our fundamental goal. To make this happen, you need to optimize end-to-end workflow – from the time patients come into the system to the time they leave the system. Imagine any end-to-end patient flow – all the necessary information and knowledge would be available right at the fingertips of each clinical stakeholder, such as radiologist, technologist, or referring physician. MEDICAL SOLUTIONS: Could you take a step back and reflect on the problems that need to be overcome in order to optimize
  13. 13. MEDICAL SOLUTIONS RSNA 2006 13 workflow for each clinical stakeholder and across the network? SINGH: Rightnow, diagnostic andtherapeutic information are poorly integrated. You have information from imaging and pathology – vast amounts of data. All the data is in the system, but it is not organized or immediately accessible. Also, you cannot convert laboratory and radiology data into high-level constructs at the patient and disease level. Multiple users cannot access it. To overcome these challenges, we’ve made knowledge-driven solutions a top priority in our agenda. Role-based Approach BIRNBAUM: If I look at our department at NYU, we still have multiple IT systems. We are currently using IDX® version 9.92 as our radi- ology information system (RIS). We use Siemens for our enterprise picture archiving and communication system (PACS), but have 3D post-processing systems from both Siemens and non-Siemens vendors. We also use different vendors for our document scan- ning and speech recognition systems. We cannot cleanly integrate these systems as is. As such, we are currently working to replace the IDX RIS with syngo Workflow. Subse- quently, weplan to drivemaximum integration between all of these systems by incorporating syngo postprocessing into our integrated syngo PACS imaging suite. Integration wins over interfacing every time. Also, what we want to achieve – and I am confident we will achieve through Siemens syngo products – is the ability to log onto the system at any place and time. When I log on, I immediately want to see a radar map of my own work- flow. This may include cases that need to be proto- colled, preliminary reports that need to be finalized, and all outstanding examinations that need to be read. Moreover, I would like my clinical section chiefs and those with executive responsibility to be able to view the workflow of individual sections or the entire department, respectively. By seeing who is in the ’green, yellow or red zones’, we will be able to redistribute the clinical work to optimize our workflow. MEDICAL SOLUTIONS: Siemens innovative syngo Suite is a pacesetting product that is setting the bar for the industry. Can you offer a snapshot of the system and how Siemens customers will benefit from using it? SINGH: The syngo Suite offers all the diag- nostic and therapeutic information collated on the same IT platform to integrate all steps: patient registration, scanning, interpretation, archivingandbilling.Alltasksthataradiologist, technologist, or referring physician performs are organized into portals. The syngo-based platform makes sure that all the tasks share a common environment and intuitive user interface. Self-explanatory icons make it easy to use. We are also eliminating the time these people spend moving from one work- stationtoanother. With syngo-based products, doctors will be able to access the system from any personal computer (PC) in the net- work. This allows them to perform the full array of reporting, reading and dictating tasks from one workstation. Our product develop- ment group is also gearing up to include oncologists and cardiologists into the net- work, enabling them to configure the system based on their clinical focus. Ultimately, we are aiming to streamline workflow not only across disciplines throughout the institution, but also between a hub and satellite facilities. With this unique bundling of competencies, we are helping our customers maintain their competitive advantage. MEDICAL SOLUTIONS: Can you describe how medical device data will be integrated into RIS, PACS and postprocessing systems? SINGH: Medical devices are data sources. We need to collate all their information into an integrated platform. Like any other data source, medical devices are enablers. This idea marks a very important paradigm shift. These very disparate data sources integrate into one IT platform. If you think of it in terms of functionality, the scanner could be sitting three miles across town, but I could be view- ing it on my PC or on any workstation in the network. MEDICAL SOLUTIONS: Siemens 64-slice computed tomography (CT) and SOMATOM® Definition scanners are among the most
  14. 14. BUSINESS IMAGE MANAGEMENT 14 MEDICAL SOLUTIONS RSNA 2006 Siemens/NYU Laboratory: Building the Next Generation of RIS and PACS Products Radiologist Bernard A. Birnbaum, MD, Vice Chairman of Radiology at New York University (NYU) Medical Center, says that the partnership between his team and Siemens has been fruitful. By the end of the year, a laboratory housed at NYU will open with the goal of jointly developing and testing Siemens next generation radiology informa- tion systems (RIS) and picture archiving and communica- tion systems (PACS) products. The information technology (IT) and the installation of latest whole-body MRI, dual-source, and 64-slice CT enable NYU and Siemens to investigate strategies to optimize high-volume reading, workflow, and data mining. They will give top priority to building new medical IT solutions with an extremely intuitive user interface. There are benefits to both partners. Siemens views the laboratory as critical in helping them provide new prototypes for medical IT products that will eventually become available across the globe. NYU wants to contribute to that vision and believes that Siemens has the outstanding capabilities and foresight to help NYU devise a medical IT solution across its enterprise-wide network, extending it from its hub in the radiology department to all satellite facilities. sophisticated in the industry. syngo Suite collects data from the CT-imaging studies and optimizes workflow. Can you tell us about your experiences with these modalities and your expectations regarding syngo Suite? BIRNBAUM: Let us use an example. A physi- cian orders a coronary CT angiography study for a patient with atypical chest pain and inconclusive prior tests. The patient would be interviewed by our staff and prepped. He or she would lie down in the machine and would not require a beta blocker. While the actual data acquisition on the SOMATOM Definition scanner takes only a few minutes, interpretation of this high volume data set remains a cumbersome process. Multiple dedicated workstations are typically used to analyze the data set, post- process the study and archive the appropriate 3D views. However, the integrated syngo- based platform will enable users to open several task-oriented software applications simultaneously. With a minimum number of mouse clicks, the study could be interpreted, dictated, and archived at a single workstation. MEDICAL SOLUTIONS: How does NYU handle the high-volume data generated by these powerful scanners? BIRNBAUM: Because these scanners may generate thousands of images per study, we need to modify our workflow accordingly. We typically archive thicker – at least four milli- meter – slices and send the thinner slices to our 3D workstations. Doing so enables us “ALL TASKS that a radiologist, technologist, or referring physician performs are organized into portals,“ explains Ajit Singh. »When you improve workflow, you also improve quality while reducing costs – that’s a fact!« Ajit Singh, PhD, Image and Knowledge Management Division, Siemens Medical Solutions
  15. 15. BUSINESS IMAGE MANAGEMENT MEDICAL SOLUTIONS RSNA 2006 15 to interrogate an optimized data set to create high-resolution postprocessed images that we then archive without sacrificing band- width and archive space. One Intuitive Platform MEDICAL SOLUTIONS: In previous conver- sations with NYU, you mentioned that the ideal system would integrate RIS, PACS, and postprocessing into one intuitive platform. Is there anything more you would like to add to that concept? BIRNBAUM: We really know exactly what we want. What we are going to do here is ensure that Siemens builds just that product, because it will achieve these goals and more. At this point in time, ideally, we would like to add on speech recognition and document scanning, and probably additional software that would allow us to immediately access information via the Internet that would pro- vide decision support. MEDICAL SOLUTIONS: To what extent will syngo be an out-of-the-box solution? How close to ’one click’ will it be? SINGH: For 80 percent of the users, the system will be out of the box. However, recognizing that some users will want to con- figure the system differently, we will build in flexibility for customizing the system. We are striving for a one-click system because the closer to one-click you are, the less invasive you need to be. With our portals for the radi- ologist, the referring physician, and more planned, we have already come a long way toward achieving this. MEDICAL SOLUTIONS: Do you expect there will be resistance to moving towards an inte- grated IT platform that optimizes workflow? SINGH: Yes. Doctors have been trained to use paper and film for the last100-plus years. It is so embedded in the curriculum. Only now the curriculum is changing to incorporate structured reporting and image handling into a computerized system. What will make it hard is this: If you make a computerized system too complicated, it will impede the thought process. You want a computer to think with you and not for you. You have to make it as transparent as possible so doctors can think about their patients and not the technology. There is also a mindset in health- care that you cannot improve quality while reducing costs. That is simply inaccurate. If you look at every other industry, you see that these goals are co-optimized. It does cost less. When you improve workflow, you also improve quality while reducing costs – that’s a fact! “INTEGRATION wins over interfacing every time,” says Bernard A. Birnbaum. »We will ensure that Siemens builds the very product we envision, because it will achieve our goals and more.« Bernard A. Birnbaum, MD, Professor of Radiology, Vice Chairman of Clinical Affairs and Operations, Department of Radiology, New York University Medical Center, USA Author: Laura Newman is a freelance medical journalist based in New York City. She has contributed articles to the Journal of the National Cancer Institute, The Lancet and the Institute of Medicine (part of the National Academy of Sciences), among others. She is also author of Developing Technologies for Early Detection of Breast Cancer (National Research Council and the National Cancer Policy Board).
  16. 16. Siemens AG Wittelsbacherplatz 2 D-80333 Munich Germany Headquarters Siemens AG, Medical Solutions Henkestr. 127, D-91052 Erlangen Germany Telephone: +49 9131 84-0 ©01.2007, Siemens AG Order-No. A91001-M2040-G733-1-7600 Printed in Germany CC IM 00001-10 SD 01071.8